Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Many patients are concerned about the cancer risks associated with breast implants, particularly given recent media attention on the rare form of cancer called Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).
Whether you already have breast implants or are considering breast implant surgery, Dr Clement believes that knowing the facts around BIA-ALCL is an important part of your decision-making and ongoing care. Dr Clement has answered some common questions around BIA-ALCL to help you stay informed.
What is Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
BIA-ALCL is a rare form of non-Hodgkin lymphoma. There are over 500 confirmed cases of BIA-ALCL worldwide. To put this in context, there are over 35 million women (60 million implants) with textured implants worldwide. If you have breast implants, your risk of developing BIA-ALCL appears to be between 1 in 2,500 and 1 in 25,000. There is no evidence of increase risk of breast cancer if you develop BIA-ALCL.
As health professionals, our understanding of the disease is still developing. There have been 16 deaths worldwide associated with BIA-ALCL, however, many of these occurred before we understood how to diagnose and treat this rare form of cancer.
What causes Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
BIA-ALCL is a complex lymphatic cancer and we are still learning about all the factors that may cause it. A more complete picture of the disease is forming all the time. Some of the contributing factors we know about include:
Textured Breast Implants – with a higher risk for high surface area textures or macro-textured rougher implants
Bacterial contamination – at the time of surgery to cause inflammation in the surrounding tissues
Genetic predisposition – whether there are genetic factors that increase your risk
Time – most BIA-ALCL occur between 3 and 14 years after implant surgery (median: 8 years; range: 1-37 years)
About 1 in 7 of patients with BIA-ALCL globally are in Australia. This is most likely due to a higher historic use of textured implants. (Until 2-3 years ago, about 85% of implants used in Australia were textured, compared to the US where 70-90% of implants are smooth. To date, all the confirmed cases in Australia have been in women with textured or polyurethane implants.
What Are the symptoms of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
BIA-ALCL is a rare disease and any changes in your breast are unlikely to be breast implant associated cancer. That said, the most common symptom of BIA-ALCL is swelling in the breast. This is caused by fluid build-up around the implant. In some cases, it may appear as a lump in the breast or armpit. Talk to Dr Clement if you have any concerns and he can monitor your breasts for any changes.
How is Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) diagnosed?
The first step is to see your GP and get referral to see a breast implant specialist like Dr Clement. We can then organise any tests you may need.
An MRI and ultrasound scan may be performed to see if any changes are due to a fluid collection. If fluid is present it will be removed and sent to the laboratory for analysis. (Remember, most fluid collections are not due to BIA-ALCL.) If confirmed, you may also need a CT scan to assess the extent of local growth or spread of the cancer. Other tests such as a PET scan may be also used to assess spread.
What is the treatment for Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
Treatment for BIA-ALCL involves a multi-disciplinary team: a blood disease specialist with experience in lymphoma, a cancer specialist and a surgeon with breast implant experience.
In about 80% of cases, the disease is detected early with cancer cells found only in the fluid surrounding the implant. In these cases, treatment involves removing the implant and surrounding capsule. Usually, both implants are removed because there is a small risk that Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) can develop in the opposite breast.
If there is a solid lump or the cancer has spread, you may need additional treatment such as chemotherapy, radiotherapy or additional surgery.
What should I do if I suspect Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?
All breast implants have a limited lifespan of 10 to 15 years and the risk of complications increase with time. If you have any concerns regarding changes to your breasts, or questions about your risk factors for developing Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), please contact Dr Clement and his team.